Forgotten Plaque

By the dawn of the 19th century, the deadliest killer in human history, tuberculosis, had killed one in seven of all the people who had ever lived. The disease struck America with a vengeance, ravaging communities and touching the lives of almost every family. The battle against the deadly bacteria had a profound and lasting impact on the country. It shaped medical and scientific pursuits, social habits, economic development, western expansion, and government policy. Yet both the disease and its impact are poorly understood: in the words of one writer, tuberculosis is our “forgotten plague.” During most of the 19th century, consumption, as tuberculosis was then called, was believed to be hereditary. Rich, poor, young, or old, the disease struck indiscriminately, and death could be sudden or painfully prolonged. Still, it was thought that a person’s environment could have an impact on the course of the illness and consumptives were advised to seek out fresh air and exercise in remote, pristine environments. Jumping on this growing interest in the “climate cure,” developers launched a massive advertising campaign aimed at luring health seekers to the newly opened territories of the West. Thousands of people with tuberculosis picked up and moved, bound for newly created towns such as Albuquerque, Colorado Springs, and Pasadena, where they formed the backbone of many new communities.

The realization that the disease was contagious came in 1882, when the tuberculosis bacillus was discovered. It would take another decade before the medical community would be convinced that a simple bacterium caused tuberculosis. As Americans came to better understand the disease, attitudes toward tuberculosis sufferers changed dramatically; no longer welcomed among the healthy, they were isolated in sanatoriums for their own health and to prevent the spread of the contagion. Dr. Edward Livingston Trudeau, whose daughter had died from TB and who was a sufferer himself, established the country’s first sanatorium at Saranac Lake, New York in 1884. Trudeau insisted on a strict regimen of fresh air — patients sat out in the cold for hours on porches. Although many patients benefitted from the isolation, others faced powerful loneliness and felt they had been banished against their will

Inspired by Robert Koch’s discovery of the tuberculosis bacterium in 1182, Dr. EdwardTrudeau did his own research in his small laboratory in Saranac Lake, N.Y. Pictured here in 1895,Trudeau was the first American to validate Koch’s findings, though the larger medical community did not accept TB as contagious for several more years. Saranac Lake Library

As Americans struggled to combat the contagion, social customs reflected the new fear of germs. Women’s hemlines rose to avoid contact with dangerous particles and men shaved their beards. And while improved hygiene started bringing the overall rate of tuberculosis down, in poor, crowded neighborhoods the numbers continued to rise. By the early decades of the 20th century, immigrants were twice as likely to die of the disease and the death rate for African Americans was three to four times higher.

Public health officials launched an unprecedented campaign to improve the lives of the poor: better housing and working conditions, reduced working hours, and child labor laws. Yet the anti-TB campaign also gave government officials unprecedented power to police the sick. Health inspectors were free to monitor people’s movements, inspect their homes, and even commit people to public institutions against their will. The war against tuberculosis raised a profound question: how should Americans balance the need to protect their communities from a highly contagious disease with the need to protect the rights of the sick to be treated with dignity and compassion?

In 1943, Albert Schatz, a young microbiologist at Rutgers University working under a pioneering scientist named Selman Waksman, discovered streptomycin, an antibiotic that seemed to be a miracle cure for tuberculosis. Streptomycin quickly proved to be a breakthrough treatment, liberating many patients from the sanatorium, but the tuberculosis bacterium was a powerful adversary, mutating into new strains that were resistant to the drug. Ultimately, combining streptomycin with other antibiotics proved more effective.

For decades, deaths from tuberculosis in the U.S. declined to the point where it seemed the disease would be eradicated. In the 1980s, it suddenly reappeared alongside the AIDS epidemic. The disease that had stalked the nation for centuries — and continues to kill millions worldwide each year — stubbornly refuses to die.

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